With so many audit possibilities in the healthcare space, it’s hard to know what’s what! Here is your rundown of different audit types and functions. Commercial Payer Audits These are audits initiated by a commercial payer and tend to focus on a particular code group (such as Evaluation and Management (E&M) codes), billing codes, specific billing patterns, adherence to payer rules, or to ensure medical record documentation supports the medical necessity. Federal Government Audits These are audits initiated by Federal government contract auditors and they tend to focus on Medicare Fee-For-Service billing.

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